Loading...
Ballet TX-LR051117CHECK ONE-- IRRIGATION DOMESTIC FIRELINE /~ BACKFLOW PREVENTION ASSElVIBLY TEST AND MAINi-~NANCE REPORT NAME OF PWS: PWS I.D. # The backflow pr=venfion assembly derailed below has been ~ and m2intslned as ~ by. TN'~CC l~_~laliol~ alld i~ e.~rl:~ed I:o be op~l'afing wjthln acceptable parameters. TYPE OF ASSEMBLY ~// R~uced Pr~ssur~ Prmciple ~ ~ V~ B~ ~ubl~ Ch~ V~v~ ~ A~o~ Vacu~ B~ Mm~a~ ~t~ S~ ~ ' ~ M~IN'~b~ ~ ~At TM ~0 t~ Serial Number REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Ass*mhly IstCheck ag,~ [2ndcheck.l~.q Relief Valve Airlnlet CheckValve Im=ial Tc=t i DC-Closed ,Closed Tight ~' Op=ned a~ Opened at psid Tight ~r' Leaked ~ psid psid 1Lv- psid ~.ao:~ L~aked r2 Did not Open ~ Leaked rn Matarials Used T~st Atm' DC-Closed Closed Tight tn Op~ned at Op~ned at ps'id R~air Tight r2 psid ~sicl RP.._~psid The above is ceni~ed to be true. C,a e # .c Aqq Date last accuracy tested Dar= White - Customer's Copy Yellow - City Copy Pink - Tester's Copy CIIECK ONE.' IRRIGATION DOMESTIC FIRELINE j BACKFLOW PREVENTION ASSEMBLY TEST AND MAINi'~CE REPORT PWS I.D. # / The backflow pI'~v~Iltioll assembly detailed below ~ beeI1 ~ snd m~i'at~i~xl as r~quir~d by. TNKCC r~la~ons and is c~rtifi~d to be op~ratin§ within acceptable pa~ ~,.~rs. TYPE OF ASSEMBLY ~ P,~luccd Pressure Principle m l~ssur~ Vacuum Breal~' Double Ch~ck Valve [] Atmosphe~ Vacuum Breaker Manufacture' ~ Siz~ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check V~lve Assembly l~Check,~,t) I 2udCheck,~,-2 RdietValve AirInlet CheckVaive lmUal T~st DC-Closed .Closed Tight ~ ~l~u~d at Op~uexi at psid Tigi~ ~" Leaked ~ psid psid PP- psid ~l~,~,~. .Mak~ m DidnotOpeu r~ L~ak~i = Ma~ial~ U~I ~ T~:~ DC-Clo~I Clo~l Tight m Ol~n~d at Ol~n~l at p$id l~air Tight m p,tid p,id RP.~.p~id The above is c~r~ified to be true. FirmName ~-} ~W.k~!no3 Gauge Ccni~d Tcmcr (~ I-~-- ~'T' }X~PJ } Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester~ Copy